Saturday, March 10, 2018

Even a Stopped Clock...

Conspiracy theories are generally nonsense, but sometimes their champions have a point.

Medical politics, at least in Canada, is a lot like life in grade 9. There's a whole lot of drama, sniping, back-stabbing, finger-pointing, passive-aggressive complaining, and reputation-sullying. To the rest of the human race, however, it's utterly pointless to follow, except perhaps as entertainment. Who doesn't love a good soap opera?

In Ontario, the ratio of signal-to-noise in medical politics is exceedingly small. Despite all the tumult of the past two years - the "civil war" over a doomed government contract; the "deluge" of bad press over social media conduct; the "palace coup" to overthrow the Ontario Medical Association (OMA) executive; and the "bitter divisions" over federal tax law changes - very little has actually changed for Ontario's doctors. They've remained without a contract for five years now, with an arbitration board's decision on a new contract still many months away. They've just held elections for OMA Council, and many of those elected were incumbents (though diversity continues to improve, with record representation by women on the new OMA Board). And for all the media circus surrounding the upcoming provincial election, none of the political parties has made any firm commitments around the province's physician workforce. So for all the drama and anguish, things are very much business as usual.
It was no surprise, then, that the OMA election results were joined in my inbox by an e-mail from Concerned Ontario Doctors (COD). As a quick recap, COD - that have been labeled in the press at various points as "extremists", "Trumpists", or worse - began as a Facebook page when the government instituted unilateral cuts to payments to doctors. They became a powerful mobilized voice for disgruntled Ontario doctors, driving opposition to the 2016 deal with the province, and pushing hard for the regime change and overhaul of the OMA. Having achieved their most immediate goals, though, COD then proceeded to break bad. Freshly elected to the OMA Board, COD members turned around and abruptly quit their positions, issuing a series of false, even paranoid accusations to the membership and the media. How or why this change came about I have not a clue. Like dozens, if not hundreds of other doctors, I've been blocked from seeing what COD has to say on every social media platform.

Like I said...a lot like grade 9.

The most recent COD e-mail centered on two major themes. First was a critique of the OMA Board's decision to erase its "Line in the Sand", a policy that recommended doctors not participate in activities of the Local Health Integration Networks (LHINs) in protest of the Patients First plan. The second theme was a group of doctors that have LHIN appointments - cited by name - the COD accuses of being co-conspirators between the OMA and the much-maligned Liberal government, to the detriment of rank-and-file members and the health care system in general.

The suggestion of any kind of conspiracy is farce. The idea that someone could parlay a position of influence in the OMA to a LHIN appointment is absurd. Even if connections could somehow help navigate the painful bureaucratic process by which the LHINs hire, the OMA has been vocally opposed to the LHINs for years. If anything, high-up OMA involvement should detract from a candidate in the eyes of a LHIN.

But as is often the case with conspiracy theories, buried underneath the wild and even false accusations are some valid points, points that demand attention if not redress. Even a stopped clock is right twice a day.

The decision around the "Line in the Sand" came seemingly out of left field. Whether it was the right decision or not, how the decision was arrived at remains a mystery. We don't know if playing nice-nice with the LHINs was a precondition to the government restarting negotiations with the OMA, which communities found (to use the OMA spokesperson's words) "significant challenges" with the policy, or what those challenges might have entailed.

And while there's nothing legally (or maybe even ethically) wrong with a government-employed doctor holding a senior position in the OMA, it gives an inescapable impression of cynical self-interest. Life isn't fair, but a government employee is going to earn his or her salary no matter how the OMA membership comes out in a negotiation with the province. It might be past time for the OMA to draw a hard line on how many masters its leaders can serve.

For all the hostility and, quite honestly, bizarre behavior the members of COD show towards their colleagues, they pay the same involuntary membership dues as the rest of Ontario's doctors. Five years is a long time to be paying (quasi-) union dues without anything to show for it, apart from more regulations, more bureaucracy, and less money in the bank. 

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